Pain and joint mobility explain individual subdimensions of the HAQ disability index in patients with RA

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Ann Rheum Dis. 2004 May 6 [Epub ahead of print]

Pain and joint mobility explain individual subdimensions of the Health

Assessment Questionnaire (HAQ) disability index in patients with

rheumatoid arthritis.

Hakkinen A, Kautiainen H, Hannonen P, Ylinen J, Arkela-Kautiainen M,

Sokka T.

Jyvaskyla Central Hospital, Finland.

OBJECTIVE: Several studies have analyzed associations between the total

score of the Health Assessment Questionnaire (HAQ) and various clinical

variables, while associations between the individual subdimensions of

the HAQ and clinical variables, particularly the function of individual

joints, have been little studied. Therefore, we conducted a study to

explore the issue in patients with rheumatoid arthritis (RA). METHODS:

Three hundred and four patients with RA (73% female, mean [sD] age 58

[13] years; disease duration 6 [9] years, 69% positive for rheumatoid

factor) completed the HAQ for functional capacity (0-3), and a 100 mm

visual analog scale for pain. Grip strength, range of motion (ROM) of

the large joints, Larsen score for radiographic damage of the joints in

hands and feet, as well as the number of tender and swollen joints were

recorded. A logit regression model was used to study associations

between the individual subdimensions of the HAQ and other variables.

RESULTS: The mean (range) total HAQ score was 0.92 (0-2.88) and varied

from 0.73 to 1.04 (0-3) in its 8 subdimensions. Disability was lowest in

the " walking " and highest in the " reach " subdimension. Pain was an

explanatory variable in all the individual subdimensions of the HAQ,

while limited knee flexion was related to all other subdimensions except

" dressing and grooming " , and " grip " . Decreased grip strength,

limitations of shoulder and wrist motion, as well as a greater number of

swollen and tender joints in the upper extremities were related to

several subdimensions of the HAQ, while Larsen score, number of swollen

and tender joints in lower extremities, and ROM of elbow to only one or

none of the subdimensions. A higher pain score and swollen joint count

in the upper extremities, decreased grip strength, and limited motion of

wrist, shoulder and knee joints explained increased disability (higher

total HAQ scores).

CONCLUSION: In patients with RA pain and range of movements of joints

impose major impact on individual subdimensions of the HAQ, while the

impacts of the extent of radiographic damage in peripheral joints, and

the numbers of swollen and tender joints appears to be of minor

importance for the functions.

PMID: 15130901

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